ON a hot day during a Spanish holiday, a Dublin-based GP watched her 13-year-old daughter stand shivering beside the pool.
The young teen — who once swam like a dolphin — was skin and bone, due to an eating disorder that had begun over a year earlier.
“She couldn’t get into the pool because she was so cold.”
And then the anxious mum saw the turning point she’d longed for, saw the moment when her beloved daughter started to get unstuck from the disordered thinking around eating that had plagued the family for months.
“She said ‘This is horrible. I don’t want this, I don’t want to live like this’.”
It had been a long journey to this moment. Distraught and panicked, Catherine had watched her bubbly, extrovert girl become unrecognisable, had seen her life shrink to “a tiny existence that centred on food, weight and shape”.
Along the way, the frantic mum met Professor Janet Treasure, a specialist in treatment of eating disorders at the South London and Maudsley Hospital, where work had been done on family-based therapy.
“They produced evidence that family-based therapy actually works.”
Crucially, Catherine learned that her daughter didn’t choose to have an eating disorder.
“It’s a biologically-based mental illness. There are genetic factors and personality predispositions.
"Parents don’t cause it — they can in fact be a powerful force in a loved one’s recovery.”
Catherine did several workshops in the New Maudsley Approach, which trains carers to be compassionate, calm and consistent. She quickly realised there’s no negotiating with an eating disorder.
“There’s no negotiating with food and mealtimes. Food is medicine. I’d say to my daughter: ‘this is what we’re having for dinner today.
"I’m making it. We’re all eating it. I will support you if you have difficulty eating it until you finish it’. It’s about being compassionate.”
Her daughter wanted to talk about food all the time.
“Instead we agreed we’d talk about it for a [designated] amount of time each day — 10 or 30 minutes.”
Happily, the now 15-year-old has “her weight restored, is healthy, full of joy and has very good emotional regulation”.
But Catherine wishes family-based therapy was more known in Ireland and that parents were professionally supported in training to re-feed their child.
“There’s a sense here that we wait for the child to want to change themselves and meanwhile their weight is dropping and they’re getting more disordered in their thinking.”
Co Down woman Debbie Howard, a 34-year-old psychotherapist, along with another eating disorder sufferer Tori Shaw and their parents set up CARED (Caring About Recovery from Eating Disorders) in Northern Ireland three years ago.
CARED teaches the New Maudsley Model, a world-renowned carers’ course designed to support, educate and empower families of those suffering from an eating disorder.
During a two-day workshop (they’re about to run their fourth workshop in Dublin next weekend), carers are taught about eating disorders, enhanced communication skills, psychology of change and how to promote recovery in their loved one.
Debbie, a former gymnast, who competed in the Commonwealth Games at 16, recalls her body always being under scrutiny for how she looked and what she weighed.
On an intense training regime, she’d skip breakfast, train for three hours and then eat a piece of dried toast and a fat-free yoghurt.
“Then I’d go to bed because of the hunger pains, after which I’d train for another three hours.”
Following university, living in London, Debbie’s eating disorder “ran riot— I hit rock bottom”.
She made a desperate call to her mum, who sourced therapy for her in London.
“I was in therapy for four years. It was a slow process of building up my self-esteem. First I wanted to get better for others. Halfway through I thought maybe I should get better for myself.
"There was no real light-bulb moment. It’s always a work in progress but the eating disorder no longer rules my life.”
During her illness, Debbie says her parents — like many parents — did the wrong thing out of love and terror.
“They shouted at me. We had hour-long stand-offs at the dinner table. They pleaded, bribed and guilted me.”
CARED teaches parents about the eating disorder ‘voice’ in the sufferer’s head that “constantly tells you you’re fat, weak, disgusting, don’t listen to them because they’re trying to make you fat”.
CARED’s aim, says Debbie, is to teach parents/carers to draw their loved one away from the eating disorder, “not push them further into its arms”.
“It’s about supporting parents to find ways to help their child make healthy choices without resorting to shouting or other negative behaviours.
“The parent might say, ‘Is there anything I can do to make eating your meal easier?’ And the sufferer might say, ‘I find it hardest after eating because I feel so guilty — maybe you can distract me, maybe we can go for a walk’.”
Susan (not her real name), another Dublin-based mum, whose daughter, in her early 20s, continues to battle her eating disorder, found CARED workshops hugely supportive.
“I realised what an eating disorder isn’t.
“It is not attention-seeking. It is not about losing weight. It’s not about a choice the sufferer has made.
"CARED made us realise that an eating disorder can control the whole family if we let it and that if we fight with our daughter about eating, we fuel the eating disorder.”
Now, if Susan’s daughter decides she wants to go to the gym and Susan doesn’t think it’s a good idea, there’s no rowing.
“I say ‘do you think it’s a good idea that you go now, seeing as you’ve been there already and you’ve done a lot of exercise?’ She might say ‘I’d like to go’. And I’d say ‘OK, you make that decision’. And she might or might not go — but we’re not fighting anymore.”
* CARED will hold a New Maudsley course at the Clayton Hotel, Leopardstown, 9.30am-4.30pm, on April 23 and 24. €50 per family.
Another workshop is planned for May.
* Approximately 200,000 people in Ireland are affected by eating disorders. About 400 new cases emerge each year, representing 80 deaths annually.
* Estimates say 10% of anorexia and bulimia cases are male, though more recent studies suggest this figure could be as high as 25%. Binge eating disorder is more equally divided, with up to 50% of cases occurring in men.
* In 2014, almost 14% of all admissions for under 18s to Irish psychiatric units/hospitals had a primary diagnosis of eating disorders. Females accounted for 93% of the eating disorder admissions.
* In 2014, 15% of calls to Bodywhys helpline related to 10 to 14-year-olds and 22% of calls involved 15 to 18-year olds.
2014 saw an 84% increase in attendance at the Bodywhys online support group for 13 to 19-year-olds.
* Bodywhys has recently run a free four-week evening course — PiLaR (Peer Led Resilience) — in five locations through Ireland.
It supports parents in dealing with issues such as anger, managing mealtimes, knowing when to step in, keeping lines of communication open and distinguishing between child and eating disorder. More courses are planned.
* Contact Bodywhys ( www.bodywhys.ie ): 1890 200444 or firstname.lastname@example.org
Also visit www.thenewmaudsleyapproach.co.uk and www.feast-ed.org